Young Rok Ham

Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

Background Bioimpedance analysis (BIA) helps measuring the constituents of the body noninvasively. Prior studies suggest that BIA-guided fluid assessment helps to predict survival in dialysis patients. We aimed to evaluate the clinical usefulness of BIA for predicting the survival rate of hemodialysis patients in Korea. Methods We conducted a single-center retrospective study. All patients were diagnosed with end-stage renal disorder and started maintenance hemodialysis between June 2009 and April 2014. BIA was performed within the 1st week from the start of hemodialysis. The patients were classified into 2 groups based on volume status measured by the body composition monitor (BCM; Fresenius): an overhydrated group [OG; overhydration/extracellular water (OH/ECW) >15%] and a nonoverhydrated group (NOG; OH/ECW ≤15%). Results A total of 344 patients met the inclusion criteria. Of these, 252 patients (73.3%) were categorized into the OG and 92 patients (26.7%) into the NOG. Age- and sex-matching patients were selected with a rate of 2:1. Finally, 160 overhydrated patients and 80 nonoverhydrated patients were analyzed. Initial levels of hemoglobin and serum albumin were significantly lower in the OG. During follow-up, 43 patients from the OG and 7 patients from the NOG died (median follow-up duration, 24.0 months). The multivariate-adjusted all-cause mortality was significantly increased in the OG (odds ratio, 2.569; P = 0.033) and older patients (odds ratio, 1.072/y; P < 0.001). No significant difference of all-cause or disease-specific admission rate was observed between the 2 groups. Conclusion The ratio of OH/ECW volume measured with body composition monitor is related to the overall survival of end-stage renal disorder patients who started maintenance hemodialysis.

ERK phosphorylation plays an important role in the protection afforded by hypothermia against renal ischemia-reperfusion injury

BACKGROUND Although hypothermia attenuates the renal injury induced by ischemia‐reperfusion, the detailed molecular pathway(s) involved remains unknown. ERK phosphorylation is known to protect against ischemia‐reperfusion injury. Also, it has been reported that hypothermia may induce ERK phosphorylation in the heart and brain. We evaluated the role played by ERK in hypothermic protection against renal ischemia‐reperfusion injury. METHODS C57Bl/6 mice were divided into the following groups: sham‐operated (cold, 32°C) vs normal temperature (37°C); ischemia‐reperfusion mice (32°C vs 37°C); and PD98059‐ or vehicle‐treated ischemia‐reperfusion mice (32°C). Kidneys were harvested 10 and 27 minutes after induction of renal ischemia and 24 hours after ischemia‐reperfusion injury. Functional and molecular markers of kidney injury were evaluated. To explore the molecular mechanism involved the expression levels of renal HIF‐1 and associated proteins were evaluated. RESULTS The blood urea nitrogen (BUN) and serum creatinine (s‐Cr) levels and the histologic renal injury scores were significantly lower in 32°C ischemia‐reperfusion than 37°C ischemia‐reperfusion kidneys (all P values < .05). The expression levels of Bax and caspase‐3 and the extent of TUNEL and 8‐OHdG cell positivity decreased, whereas the renal Bcl‐2 level increased, in 32°C ischemia‐reperfusion compared to 37°C ischemia‐reperfusion mice. The extent of renal ERK phosphorylation was significantly higher in ischemia‐reperfusion than sham‐operated kidneys. Also, ERK phosphorylation was significantly increased in the kidneys of 32°C compared to 37°C ischemia‐reperfusion mice. PD98059 treatment of 32°C ischemia‐reperfusion mice significantly decreased the renal HIF‐1 level (P < .05) and increased the BUN, s‐Cr, renal Bax, and caspase‐3 expression levels; the tissue injury score; and the proportions of TUNEL‐ and 8‐OHdG–positive cells. PD98059 also increased the renal Bcl‐2 level in such mice. CONCLUSION Hypothermia attenuates the renal apoptosis and oxidative stress induced by ischemia‐reperfusion via a mechanism involving ERK phosphorylation.

Spinning: an arising cause of rhabdomyolysis in young females.

‘Spinning’ is an indoor cycling regimen. The number of case reports of spinning‐induced rhabdomyolysis (SIR) has increased since 2004 in South Korea.

Growth differentiation factor 15 as a predictor of adverse renal outcomes in patients with immunoglobulin A nephropathy

Growth differentiation factor 15 (GDF 15) has recently been reported as a useful prognostic marker in patients with chronic inflammatory disease and heart disease.

Prognostic Relationships between Microbleed, Lacunar Infarction, White Matter Lesion, and Renal Dysfunction in Acute Ischemic Stroke Survivors

BACKGROUND It is well known that renal dysfunction and cerebral small-vessel disease (SVD), including microbleed, lacunar infarction, and white matter lesion (WML), are associated with poor prognosis after ischemic stroke. However, the prognostic relationship between renal dysfunction and SVD has not been well evaluated in acute ischemic stroke survivors. Therefore, in this study, we evaluated the prognostic relationships between estimated glomerular filtration rate (eGFR) and cerebral SVD after acute ischemic stroke. METHODS We retrospectively reviewed the clinical and radiological data of acute ischemic stroke survivors with decreased eGFR (<60 mL/min/1.73 m2, n = 128) and controls (eGFR ≥60 mL/min/1.73 m2, n = 128). The presence of SVD was evaluated according to magnetic resonance imaging performed on admission. Mortality data were obtained from medical chart reviews and telephone interviews. RESULTS Patients with silent lacunar infarction, WML, or microbleed had lower eGFR than patients without such lesions (60.4 ± 34.8 versus 87.5 ± 28.4 mL/min/1.73 m2, 60.5 ± 37.1 versus 73.9 ± 33.3 mL/min/1.73 m2, and 57.6 ± 33.3 versus 73.9 ± 32.9 mL/min/1.73 m2, respectively). In addition, the multivariate adjusted odds ratio for the presence of SVD increased inversely with eGFR. Three-year survival was lower in patients with renal dysfunction and each type of SVD. The presence of WML was an independent risk factor for cardiovascular death. CONCLUSIONS Renal impairment was associated with the presence of SVD in acute ischemic stroke survivors. Both renal impairment and the presence of SVD were predictors of poor poststroke survival.

Clinical Characteristics of Overhydration in Patients with Idiopathic Edema.

Background: Idiopathic edema (IE) is a common clinical syndrome. Designing treatment plans for IE is problematic because of the difficulty in assessing volume status. We aimed to evaluate volume status, measured by bioimpedance spectroscopy (BIS), and investigated clinical parameters associated with volume overload (VO) in patients with IE. Methods: Patients with IE were defined as those with symptomatic edema and without abnormal renal function or any other apparent cause of edema. A total of 124 patients were included. Overhydration (OH) and extracellular water (ECW) were calculated using BIS. Relative hydration status (ΔHS) was defined as OH/ECW. Patients were classified into 2 groups: overhydrated group (OG; ΔHS ≥7%) and non-OG (NOG; ΔHS <7). Simple and multiple logistic regression analyses were used to assess the influence of several variables on the incidence of VO. Results: Of 124 patients, 37 (29.8%) were in the OG. The proportion of men in the OG was higher than that in the NOG (p = 0.020). Patients in the OG showed more frequent pretibial pitting edema (PTPE, p < 0.001) and had lower hemoglobin (p = 0.008) and serum albumin levels (p < 0.001). The multivariate analysis showed that the presence of PTPE (OR 10.62, 95% CI 1.98-57.1), low serum albumin level (OR 0.01, 95% CI 0.00-0.25) and lower fat tissue index (OR 0.78, 95% CI 0.63-0.97) were independent risk factors for the presence of VO. Conclusions: BIS helps to identify volume status and body composition in patients with IE.

Growth Differentiation Factor-15 as a Predictor of Idiopathic Membranous Nephropathy Progression: A Retrospective Study

Idiopathic membranous nephropathy (IMN) is a major cause of nephrotic syndrome. No biomarker to predict the long-term prognosis of IMN is currently available. Growth differentiation factor-15 (GDF-15) is a member of the transforming growth factor-β superfamily and has been associated with chronic inflammatory disease. It has the potential to be a useful prognostic marker in patients with renal diseases, such as diabetic nephropathy and IgA nephropathy. This study examined whether GDF-15 is associated with the clinical parameters in IMN and showed that GDF-15 can predict IMN disease progression. A total of 35 patients with biopsy-proven IMN, treated at Chungnam National University Hospital from January 2010 to December 2015, were included. Patients younger than 18 years, those with secondary membranous nephropathy, and those lost to follow-up before 12 months were excluded. Levels of GDF-15 at the time of biopsy were measured using enzyme-linked immunosorbent assays. Disease progression was defined as a ≥30% decline in estimated glomerular filtration rate (eGFR) or the development of end-stage renal disease. The mean follow-up was 44.1 months (range: 16–72 months). Using receiver operating curve analysis, the best serum GDF-15 cut-off value for predicting disease progression was 2.15 ng/ml (sensitivity: 75.0%, specificity: 82.1%, p = 0.007). GDF-15 was significantly related to age and initial renal function. In the Kaplan-Meier analysis, the risk of disease progression increased in patients with GDF-15 ≥ 2.15 ng/ml when compared with those with GDF-15 < 2.15 ng/ml (50.0% versus 9.7%) (p = 0.012). In the multivariate Cox regression analysis adjusted for potential confounders, only GDF-15 was significantly associated with disease progression in IMN (p = 0.032). In conclusion, the GDF-15 level at the time of diagnosis has a significant negative correlation with initial renal function and is associated with a poor prognosis in IMN. Our results suggest that GDF-15 provides useful prognostic information in patients with IMN.

Endogenous Bacterial Endopthalmitis from Long-term Use of a Tunneled Cuffed Hemodialysis Catheter Infection

https://doi.org/10.4068/cmj.2018.54.2.129 C Chonnam Medical Journal, 2018 Chonnam Med J 2018;54:129-130 Corresponding Author: Ki Ryang Na Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Korea Tel: +82-42-280-8106, Fax: +82-42-257-5753, E-mail: drngr@hanmail.net Article History: Received March 22, 2018 Revised April 6, 2018 Accepted April 19, 2018 FIG. 1. (A) The exit site of the tunneled cuffed hemodialysis catheter. Slit lamp examination in the left eye (B). Fundoscopy in the right eye (C) and in the left eye (D) at the time of admission. Slit lamp examination in aggravated left eye (E) on day 11 after admission. Endogenous Bacterial Endopthalmitis from Long-term Use of a Tunneled Cuffed Hemodialysis Catheter Infection

Acute Visual Loss due to Acute Angle-Closure Glaucoma after Kidney Transplantation

Acute angle-closure glaucoma is an ocular emergency and is distinct due to its acute presentation, need for immediate treatment, and well-established anatomic pathology. Although some patients develop increased intraocular pressure after kidney transplantation, few patients are diagnosed with glaucoma. Most glaucoma that appears after kidney transplantation is of the open-angle type and is probably associated with steroid treatment. Acute angleclosure glaucoma after kidney transplantation is rare. We report a case of acute angle-closure glaucoma, suggested to be steroid independent that developed after kidney transplantation and resulted in progression to permanent visual loss.

A Case of Membranous Glomerulonephritis with Superimposed Anti-Neutrophil Cytoplasmic Antibody-Associated Rapidly Progressive Crescentic Glomerulonephritis.

Idiopathic membranous glomerulonephritis (IMGN) is commonly diagnosed in adults with proteinuria. Rapid deterioration of renal function is a rare complication of IMGN, except when accompanied by renal vein thrombosis, malignant hypertension, or other underlying disease, including lupus nephritis. Here, we present a case of rapid deterioration of renal function in a patient with MGN superimposed with anti-neutrophil cytoplasmic antibody (ANCA)-associated rapidly progressive crescentic glomerulonephritis (RPGN). Overall, about 20 cases of MGN with ANCA-associated RPGN have been reported. This case of biopsy-proven MGN with ANCA-associated RPGN is the first to be reported in Korea.